In Degenerative Spondylolisthesis, Unilateral Laminotomy for Bilateral Decompression Leads to Less Reoperations at 5 Years When Compared to Posterior Decompression With Instrumented Fusion A Propensity-matched Retrospective Analysis
In Degenerative Spondylolisthesis, Unilateral Laminotomy for Bilateral Decompression Leads to Less Reoperations at 5 Years When Compared to Posterior Decompression With Instrumented Fusion A Propensity-matched Retrospective Analysis
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DOI：
10.1097/brs.0000000000003121
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发表时间：
2019-11-01
期刊：
影响因子：
3
通讯作者：
Bains, Ravinder S.
中科院分区：
文献类型：
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作者：
Kuo, Calvin C.;Merchant, Maqdooda;Bains, Ravinder S.
研究设计。多中心回顾性队列研究。客观的。本研究的目的是在多中心数据库中比较单侧椎板切开术双侧减压 (ULBD) 与后路减压加器械融合 (Fusion) 治疗低度退行性脊柱滑脱 (DS) 伴腰椎管狭窄 (LSS) 患者的 5 年随访再手术率。背景数据摘要。对于合并 DS 的 LSS 患者是否应该使用融合术来加强减压手术存在争议。多年来，该标准一直与标准椎板切除术融合，以防止术后不稳定。然而，这一策略没有得到 1 级证据的支持。使用微创减压技术可以减少或防止不稳定和再次手术。方法。我们在一个多中心数据库中确定了 2007 年 1 月至 2011 年 12 月期间接受 ULBD 的 164 名 DS 和 LSS 患者。这些患者在年龄、性别、种族和吸烟状况方面与接受 Fusion 的患者 (n = 437) 进行倾向评分匹配。每个患者都需要至少 5 年的随访。主要结局是 5 年再次手术。次要结果指标包括术后并发症发生率、手术期间失血量和住院时间。使用逻辑回归模型来估计两个手术组之间5年再手术率的比值比。结果。 5 年随访时，ULBD 组的再手术率为 10.4%，Fusion 组为 17.2%。 ULBD 再次手术在指数手术水平上更为频繁；融合再手术在相邻节段更为常见。两种手术的术后并发症发生率相似，且两组均倾向于再次进行融合手术。结论。对于稳定的 DS 和 LSS 患者，与融合术相比，ULBD 是一种可行、持久的选择，可减少失血量和住院时间，并且 5 年随访时的再手术率较低。需要进一步的前瞻性研究来确定 DS 背景下 ULBD 的最佳临床方案。
Study Design. Multicenter retrospective cohort study. Objective. The aim of this study was to compare reoperation rates at 5-year follow-up of unilateral laminotomy for bilateral decompression (ULBD) versus posterior decompression with instrumented fusion (Fusion) for patients with low-grade degenerative spondylolisthesis (DS) with lumbar spinal stenosis (LSS) in a multicenter database. Summary of Background Data. Controversy exists regarding whether fusion should be used to augment decompression surgery in patients with LSS with DS. For years, the standard has been fusion with standard laminectomy to prevent postoperative instability. However, this strategy is not supported by Level 1 evidence. Instability and reoperations may be reduced or prevented using less invasive decompression techniques. Methods. We identified 164 patients with DS and LSS who underwent ULBD between January 2007 and December 2011 in a multicenter database. These patients were propensity score-matched on age, sex, race, and smoking status with patients who underwent Fusion (n = 437). Each patient required a minimum of 5-year follow-up. The primary outcome was 5-year reoperation. Secondary outcome measures included postoperative complication rates, blood loss during surgery, and length of stay. Logistic regression models were used to estimate the odds ratio of the 5-year reoperation rate between the two surgical groups. Results. The reoperation rate at 5-year follow-up was 10.4% in the ULBD group and 17.2% in the Fusion group. ULBD reoperations were more frequent at the index surgical level; Fusion reoperations were more common at an adjacent level. The two types of operations had similar postoperative complication rates, and both groups tended to have fusion reoperations. Conclusion. For patients with stable DS and LSS, ULBD is a viable, durable option compared to fusion with decreased blood loss and length stay, as well as a lower reoperation rate at 5-year follow-up. Further prospective studies are required to determine the optimal clinical scenario for ULBD in the setting of DS.